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Concealed conduction and dual pathway physiology of the atrioventricular node

Liu, SW; Olsson, Bertil LU ; Yang, YZ; Hertervig, Eva LU ; Kongstad Rasmussen, Ole LU and Yuan, Shiwen LU (2004) In Journal of Cardiovascular Electrophysiology 15(2). p.144-149
Abstract
AV Nodal Duality and Concealment. Introduction: Both concealed conduction and dual pathway physiology are important electrophysiologic characteristics of the AV node. The interaction of AV nodal concealment and duality, however, is not clearly understood. Methods and Results: The properties of AV conduction curves in the presence and absence of a conditioning blocked impulse were prospectively studied during premature atrial stimulation in 20 patients with AV nodal reentrant tachycardia before and after slow pathway ablation and in 14 control patients. AV nodal duality in the control conduction curve in the absence of a conditioning impulse was observed in 19 (95%) of 20 patients with AV nodal reentrant tachycardia. However, AV nodal... (More)
AV Nodal Duality and Concealment. Introduction: Both concealed conduction and dual pathway physiology are important electrophysiologic characteristics of the AV node. The interaction of AV nodal concealment and duality, however, is not clearly understood. Methods and Results: The properties of AV conduction curves in the presence and absence of a conditioning blocked impulse were prospectively studied during premature atrial stimulation in 20 patients with AV nodal reentrant tachycardia before and after slow pathway ablation and in 14 control patients. AV nodal duality in the control conduction curve in the absence of a conditioning impulse was observed in 19 (95%) of 20 patients with AV nodal reentrant tachycardia. However, AV nodal duality in the modulated conduction curve in the presence of a blocked impulse was only identified in 2 (10%) of 20 patients (2/20 vs 19/20, P < 0.0001). The modulated curve was characterized by a significantly longer AV nodal effective and functional refractory periods compared to the control curve (P < 0.0001) in both patients with and without AV nodal reentry and in AV nodal reentry patients after successful slow pathway ablation. The maximum AH interval (AH(max)) of the modulated curve was significantly shorter than the control curve in both patients with (217 +/- 74 ms vs 347 +/- 55 ms, P < 0.0001) and without AV nodal reentry (178 +/- 50 ms vs 214 +/- 54 ms, P = 0.02). AH(max) of the control curve was significantly longer in AV nodal reentry patients than in controls (P < 0.0001). AH(max) of the modulated curve, however, was not significantly different between the two groups. After slow pathway ablation, AHmax of the control curve was significantly reduced (347 +/- 55 ms vs 191 +/- 40 ms, P < 0.0001). Significant reduction in AH(max) of the modulated curve was not observed. Conclusion: An interaction of AV nodal concealed conduction and dual pathway physiology was demonstrated by our data. Slow pathway conduction of the AV node was prevented by the concealed beat in both patients with and without AV nodal reentry. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
concealed conduction, reentrant tachycardia, atrioventricular nodal, dual pathway physiology, atrioventricular node, atrial fibrillation, slow, pathway ablation
in
Journal of Cardiovascular Electrophysiology
volume
15
issue
2
pages
144 - 149
publisher
Wiley-Blackwell
external identifiers
  • wos:000220030200001
  • pmid:15028041
  • scopus:1542350217
ISSN
1540-8167
DOI
10.1046/j.1540-8167.2004.03301.x
language
English
LU publication?
yes
id
4ae8df85-ff70-44d2-9950-42bbee2fe88f (old id 285168)
date added to LUP
2007-10-24 20:07:24
date last changed
2017-01-01 05:14:34
@article{4ae8df85-ff70-44d2-9950-42bbee2fe88f,
  abstract     = {AV Nodal Duality and Concealment. Introduction: Both concealed conduction and dual pathway physiology are important electrophysiologic characteristics of the AV node. The interaction of AV nodal concealment and duality, however, is not clearly understood. Methods and Results: The properties of AV conduction curves in the presence and absence of a conditioning blocked impulse were prospectively studied during premature atrial stimulation in 20 patients with AV nodal reentrant tachycardia before and after slow pathway ablation and in 14 control patients. AV nodal duality in the control conduction curve in the absence of a conditioning impulse was observed in 19 (95%) of 20 patients with AV nodal reentrant tachycardia. However, AV nodal duality in the modulated conduction curve in the presence of a blocked impulse was only identified in 2 (10%) of 20 patients (2/20 vs 19/20, P &lt; 0.0001). The modulated curve was characterized by a significantly longer AV nodal effective and functional refractory periods compared to the control curve (P &lt; 0.0001) in both patients with and without AV nodal reentry and in AV nodal reentry patients after successful slow pathway ablation. The maximum AH interval (AH(max)) of the modulated curve was significantly shorter than the control curve in both patients with (217 +/- 74 ms vs 347 +/- 55 ms, P &lt; 0.0001) and without AV nodal reentry (178 +/- 50 ms vs 214 +/- 54 ms, P = 0.02). AH(max) of the control curve was significantly longer in AV nodal reentry patients than in controls (P &lt; 0.0001). AH(max) of the modulated curve, however, was not significantly different between the two groups. After slow pathway ablation, AHmax of the control curve was significantly reduced (347 +/- 55 ms vs 191 +/- 40 ms, P &lt; 0.0001). Significant reduction in AH(max) of the modulated curve was not observed. Conclusion: An interaction of AV nodal concealed conduction and dual pathway physiology was demonstrated by our data. Slow pathway conduction of the AV node was prevented by the concealed beat in both patients with and without AV nodal reentry.},
  author       = {Liu, SW and Olsson, Bertil and Yang, YZ and Hertervig, Eva and Kongstad Rasmussen, Ole and Yuan, Shiwen},
  issn         = {1540-8167},
  keyword      = {concealed conduction,reentrant tachycardia,atrioventricular nodal,dual pathway physiology,atrioventricular node,atrial fibrillation,slow,pathway ablation},
  language     = {eng},
  number       = {2},
  pages        = {144--149},
  publisher    = {Wiley-Blackwell},
  series       = {Journal of Cardiovascular Electrophysiology},
  title        = {Concealed conduction and dual pathway physiology of the atrioventricular node},
  url          = {http://dx.doi.org/10.1046/j.1540-8167.2004.03301.x},
  volume       = {15},
  year         = {2004},
}